Endocrine Abstracts

JOINT2509

Introduction: Arterial hypertension is a common pathology affecting a significant proportion of the population. It can be classified into different forms, including essential hypertension and secondary hypertension essential hypertension accounts for around 90-95% of cases, and is often multifactorial in origin Obesity is a major risk factor, with obese women 3 times more likely to suffer from hypertension. Conversely, endocrine-induced hypertension is rarer. In this observation, we report a case of endocrine hypertension, under-diagnosed due to the presence of multiple cardiovascular risk factors and a borderline age.

Observation: This is a 49-year-old obese patient, with BMI of 39, treated for dyslipidemia, with 11 years history of hypertension discovered at the age of 38, revealed by grade 3 hypertension, initially followed by a cardiologist who put her on dual therapy without any secretory test. The patient was referred to us as part of goitre exploration, and secondary hypertension was suspected in view of the age of onset before 40, with uncontrolled hypertension on tritherapy. Examination revealed a BP of 170/69, grade 2 obesity with no signs of hypercorticism. The workup revealed hypokalemia at 3.5 cardiac and renal Doppler were normal a secretory work-up was requested after correction of the hypokalemia and adaptation of the treatment to avoid any risk of drug interactions. The aldosterone renin ratio was positive at 231, indicating primary hyperaldosteronism. Abdominopelvic CT revealed a 15 mm left adrenal nodule. The patient was referred for surgery with good clinical improvement.

Discussion: Overweight and obesity, especially in women, are a clear risk factor for hypertension. Endocrine hypertension can often be confused with essential hypertension, especially in obese patients, due to a similar symptomatology. To avoid overlooking an endocrine cause, a thorough clinical and biological evaluation is essential. Consideration should be given to age of onset, resistance to treatment, presence of hypokalemia. Failure to consider endocrine causes in the context of obesity can have serious hydroelectrolytic and long-term cardiovascular consequences (cererbral stroke, infarction).

Conclusion: Diagnosis of endocrine hypertension in obese patients can be complex, given the similarity of symptoms between essential hypertension and certain endocrine pathologies. consideration of specific tests can differentiate these two entities and ensure optimal management